Objective: Current resuscitation protocols require pausing chest compressions during cardiopulmonary resuscitation (CPR) to check for a pulse. However, pausing CPR during a pulseless rhythm can worsen patient outcome. Our objective is to design an ECG-based algorithm that predicts pulse status during uninterrupted CPR and evaluate its performance. Methods: We evaluated 383 patients being treated for out-of-hospital cardiac arrest using defibrillator data. We collected paired and immediately adjacent ECG segments having an organized rhythm. Segments were collected during the 10s period of ongoing CPR prior to a pulse check, and 5s segments without CPR during the pulse check. ECG segments with or without a pulse were identified by the audio annotation of a paramedics pulse check findings and recorded blood pressures. We developed an algorithm to predict the clinical pulse status based on the wavelet transform of the bandpass-filtered ECG, applying principle component analysis. We then trained a linear discriminant model using 3 principle component modes. Model performance was evaluated on test group segments with and without CPR using receiver operating curves and according to the initial arrest rhythm. Results: There were 230 patients (540 pulse checks) in the training set and 153 patients (372 pulse checks) in the test set. Overall 38% (351/912) of checks had a spontaneous pulse. The areas under the receiver operating characteristic curve (AUCs) for predicting pulse status with and without CPR on test data were 0.84 and 0.89, respectively. Conclusion: A novel ECG-based algorithm demonstrates potential to improve resuscitation by predicting presence of a spontaneous pulse without pausing CPR. Significance: Our algorithm predicts pulse status during uninterrupted CPR, allowing for CPR to proceed unimpeded by pauses to check for a pulse and potentially improving resuscitation performance.
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